The Full Prenatal Care Guide

Getting good healthcare during your pregnancy is important for both you and your baby.

Prenatal care helps boost your chances of having a full-term pregnancy and delivering a healthy baby. Plus, having regular visits to your healthcare provider offers a great opportunity to get answers to any questions you have about your pregnancy and the birth of your baby.

You have lots of choices when it comes to your prenatal care. This guide can help you understand what types of prenatal care may be offered to you, and describes some of the options you may have.

Read on to find out why prenatal care is important, how to choose a good prenatal healthcare provider, what happens during your prenatal care visits, what tests might be recommended to you as part of your prenatal care schedule, and more.

What Prenatal Care Is and Why It’s Important

Prenatal care, as the name suggests, is the healthcare you get during your pregnancy. It consists of regular medical checkups that may include various types of tests and exams, along with a chance to discuss what might happen when it comes to your pregnancy, labor, and the delivery of your baby.

If you're wondering why prenatal care is important, it’s because it helps keep you and your baby healthy and safe. With prenatal care, your doctor, nurse, or midwife can spot any health problems early and treat them. Another benefit of prenatal care is that you have the opportunity to get guidance from your healthcare provider on how to have a healthy pregnancy.

It’s ideal if you visit your healthcare provider when you first decide you want to get pregnant. Taking care of your health and preparing for a successful conception helps put you on the path to a healthy pregnancy.

If you’ve just discovered that you’re pregnant and you didn’t get a chance to visit your provider beforehand, don’t worry. You’ll certainly still benefit from great prenatal care to help ensure you have a healthy pregnancy.

Once you’ve chosen a prenatal care provider, she will plan your prenatal care schedule, including the timing of your first prenatal checkup.

How to Choose Your Prenatal Care Doctor

Finding a healthcare provider is one of the most important decisions you’ll make in the early stages of your pregnancy.

You’ll want to choose a prenatal healthcare provider with a good reputation, of course, but it’s also crucial that she listens to you, cares about your preferences, and respects you. The key is to choose someone you feel comfortable with.

Another thing to consider as you begin your search for a prenatal healthcare provider is where you want to have your baby. If you’d prefer to have your baby at a specific hospital or birthing center, or if you’re considering a home birth, make sure your provider supports your choice and can deliver your baby in the place you want.

Your current healthcare provider can give you recommendations for a prenatal care provider, and you may also want to ask moms in your circle for their opinions about their prenatal healthcare providers.

Your health insurance provider will also have a list you can check to help you find a prenatal care provider.

As you do your research, you’ll find there are different types of healthcare providers who can give you care during pregnancy, labor, and childbirth. Depending on your pregnancy and preferences, you may end up with one or a combination of the following:

• Obstetrician-gynecologists (ob-gyns). These medical doctors specialize in women’s healthcare.

• Maternal-fetal medicine specialists. These doctors, also called perinatologists, have the same specialized training as ob-gyns do, plus additional training in high-risk obstetrics. This kind of doctor may be what you need if yours is a high-risk pregnancy.

• Family physicians. Family care doctors also have some training in obstetrics. A family physician can care for you if yours is a low-risk, straightforward pregnancy.

• Certified nurse-midwives (CNMs) and certified-midwives (CMs). These specially trained practitioners can provide care if you have a low-risk pregnancy. CNMs are registered nurses with a graduate degree in midwifery. CMs have graduated from an accredited midwifery educational program. CMs have completed the same midwifery requirements as CNMs but don’t have the additional training that nurses have. Both usually work with a qualified medical doctor, like an ob-gyn or a family physician, who provides additional support.

• Family nurse practitioners (FNPs) or women's health nurse practitioners (WNPs). These nurses receive advanced training in caring for all family members or in caring for women of all ages, including pregnant women.

• Doulas. Doulas aren’t medically trained and don’t stand in for a doctor or nurse, but they are trained to help coach you through your labor. Doulas can be supportive for you and your partner during childbirth and postpartum.

Timing of Your Prenatal Checkups

As soon as you find out that you're pregnant, call your healthcare provider's office to set up an appointment. This first prenatal visit might take place as early as 6 to 8 weeks of pregnancy.

If you don’t have any risk factors that complicate your pregnancy, your prenatal care provider may recommend the standard schedule for checkups, which is:

• Every 4 weeks until you’re 28 weeks pregnant

• Every 2 weeks between 28 and 36 weeks

• Once a week from 36 weeks until the birth of your baby.

If yours is a high-risk pregnancy or if a special circumstance arises, your healthcare provider may recommend scheduling additional tests or more frequent prenatal checkups.

Your provider will determine whether your pregnancy is considered high risk by taking into account certain factors, such as if you

• are 35 or older, or are 17 or younger

• were underweight or overweight before you become pregnant

• have high blood pressure, diabetes, depression, or another health issue

• are pregnant with twins, triplets, or other multiples

• had a previous pregnancy that included problems such as premature labor, or had a child with a birth defect.

What Might Happen at Your Prenatal Care Visits

Most of your prenatal checkups will include:

• Checking your weight and blood pressure

• Measuring your abdomen to monitor your baby’s growth

• Checking your baby’s heart rate.

During each of your visits, your healthcare provider will ask several questions and sometimes offer you various prenatal tests.

Between visits, keep a list of any questions or concerns you have, and be sure to raise them during your next prenatal visit.

Of course, if something is urgent or distressing, or if you experience a pregnancy symptom you think shouldn’t be ignored, you can reach out to your healthcare provider anytime at all.

Types of Prenatal Tests

Prenatal tests are various medical tests you’ll be offered throughout your pregnancy. Some prenatal tests will be done several times during your pregnancy, and some you’ll get only at certain times or under specific conditions.

Two primary types of prenatal tests are screening tests and diagnostic tests:

• Screening tests. These standard prenatal tests help determine if there’s a chance of a possible health risk for you or your baby. If screening tests show that you or your baby might be at risk for some kind of health condition, then a diagnostic test may be recommended. Screening tests typically pose no risk to you or your baby. Standard screening tests check things like:

• Your blood type

• Your blood pressure, which can help determine if you have a blood pressure disorder called preeclampsia

• Whether or not you have a health condition such as anemia or gestational diabetes

• Whether or not you have an STD or cervical cancer

• Your protein levels, signs of infection, or blood sugar levels

• Your baby’s size, age, and position in your uterus.

• Diagnostic tests. These tests help your healthcare provider confirm whether your baby has a certain health condition. Diagnostic tests are conducted when results from a screening test indicate there might be a risk for you or your baby. Some diagnostic tests carry a slight risk for miscarriage, for example. Your healthcare provider will explain the risks and benefits so that you can make an informed choice about whether you would like such a test.

First Trimester Prenatal Care: Visits and Tests

During your first prenatal care visit, you’ll get a complete physical exam, have blood tests done, and get an estimate of your due date, which will let you know approximately how far along you are.

Your healthcare provider may prescribe you prenatal vitamins, such as a prenatal multivitamin that contains folic acid.

Folic acid is an important vitamin that can help protect your baby from neural tube defects and also from cleft lip and palate.

You might also be offered vaccinations, like a flu shot.

Your first prenatal care visit will include your healthcare provider taking a full health history, and you’ll be asked about your lifestyle and relationships, among other things. Be open and honest, because your answers help your provider determine how to provide you with the best prenatal care possible.

If you don’t feel comfortable sharing openly with your provider, consider finding one you trust.

During your first or second prenatal care visit, you may also have a pelvic exam, a breast exam, and a cervical exam, which includes a Pap test.

Your provider will also check your uterus. Some healthcare providers may do this via an ultrasound exam.

Near the end of your first trimester, your healthcare provider might use what’s called a Doppler to listen to your baby’s heartbeat. This is a thrilling moment as you finally get to hear that wonderful sign of life.

Here are descriptions of some tests and exams your prenatal care provider might recommend during the first trimester:

• Early ultrasound. This helps determine how far along you are and also measures the clear space in the tissue at the back of your baby’s neck, called nuchal translucency. This screening test can give your healthcare provider important information about your baby’s health and development.

• A blood test. This helps determine, among other things, your blood type and your hemoglobin levels. Low hemoglobin levels can be a sign that you have anemia, which can make you feel extremely fatigued. This test will also be used to check your Rh (Rhesus) factor, a protein on the surface of red blood cells. Most people have this protein, and are what's known as Rh positive. However, if you’re Rh negative and your baby is Rh positive, this Rh incompatibility may sometimes lead to health problems. Your healthcare provider will know how to manage this condition to keep you and your baby healthy.

• Carrier screening test. This is a test of your blood or saliva to determine if you’re a carrier of certain genetic conditions that could have an effect on your baby.

• Cell-free fetal DNA testing. Sometimes called a noninvasive prenatal screening, this test checks your blood for your baby’s DNA to see if certain genetic conditions may be present. Depending on the result, your healthcare provider may recommend further diagnostic testing, like amniocentesis.

• Chorionic villus sampling. Also called CVS, this is a diagnostic test that checks the placental tissue to determine if your baby has a genetic condition like Down syndrome. Your healthcare provider will only recommend this diagnostic test if you have a screening test, such as the cell-free fetal DNA test, for example, that indicates there might be an issue.

Second Trimester Prenatal Care: Visits and Tests

During your second trimester prenatal care visits, your healthcare provider will

• check your baby’s movement

• monitor your baby’s heartbeat

• track your baby’s growth.

Your healthcare provider will also continue to check your weight and blood pressure at every visit.

These prenatal tests, should you choose to have them, might be done during the second trimester:

• Quad test. Also called maternal blood screening, this blood test measures four different substances in your blood to screen for things like Down syndrome or Edwards syndrome (trisomy 18). The substances measured in the QUAD test include the protein called alpha-fetoprotein and the pregnancy hormone hCG.

• Ultrasound. An ultrasound exam can help your healthcare provider check for birth defects, see the position of the placenta, and track your baby’s growth. It’s also possible in a second trimester ultrasound to determine your baby’s gender.

• Glucose screening. This tests to see if you might have gestational diabetes.

Third Trimester Prenatal Care: Visits and Tests

At one of your prenatal visits, your healthcare provider may recommend you start doing kick counts (also called fetal movement counts) to track how often your baby moves. Your provider will explain how to do these, but you may find this Fetal Movement Tracker helpful.

You might be offered a Tdap vaccination, which is a vaccination that protects you and your baby against pertussis (also called whooping cough), an infection that's very dangerous for newborns, as well as tetanus and diphtheria.

Near the end of your third trimester, at around 36 weeks,, you’ll start having weekly prenatal checkups. Your healthcare provider will continue to check your baby’s heartbeat and movement, as well as your blood pressure and weight gain.

Your healthcare provider will also check the position of your baby. If your baby is not facing head down — for example, if he’s in a breech position — your provider will discuss your options with you.

This prenatal test, should you choose to have it, is done during the third trimester:

• Group B strep test. Also called GBS, this tests fluid from your cervix to make sure you don’t have a strep infection that you could pass to your baby during delivery.

Prenatal Care Cost

The extra expense of prenatal care can be overwhelming even if you have health insurance.

Fortunately, every state has a program to help with prenatal care. If you’d like to see what no-cost or low-cost care you’re eligible for, start by contacting the U.S. Department of Health and Human Services or your local Health Department.

You might also find help through

• local hospitals or social service agencies

• the federal Women, Infants, and Children (WIC) Program

• community clinics

• places of worship.

Staying healthy during pregnancy, and helping your baby grow and develop, starts with good prenatal care. We hope our prenatal care guidelines have helped you better understand the benefits of prenatal care and given you a rough idea of your prenatal care schedule for the coming weeks, months, and trimesters of your pregnancy.